No abstract

This article identifies and explores how the internalised racism of racial minority clients is identified and treated clinically by white psychotherapists. Four psychotherapists, who selfidentified as “white”, participated in semi-structured interviews, exploring their perceptions and understandings of how internalised racism and racism manifested within the clinical setting. The data from these interviews was analysed using thematic analysis and produced four main themes: manifestations of internalised racism and racism in therapy, disidentification, therapist’s explicitness, and connection to culture. These themes were supported and anchored by four sub-themes. The themes represent a therapeutic process of: emergence, understanding, intervention and aim. The emergence of racism and internalised racism in therapy describes both the clients’ and the psychotherapists’ experiences of internalised racism and racism as it emerges in the therapeutic encounter. Dis-identification captures the psychotherapists’ understanding of internalised racism operating as their minority clients’ dis-identification with their racial and cultural heritage. Therapist’s explicitness identifies a therapeutic intervention, the psychotherapist’s communication to their minority clients about the racial differences between them. And finally, connection to culture captures the psychotherapist’s therapeutic aim of encouraging a connection to racial and cultural heritage as a protective factor against racism and emotional and psychological difficulties. Whakarāpopotonga E tautuhi e tūhura ana tēnei tuhinga pēhea ai te tautuhi te whakaora a ngā kaiwhakaora hinengaro kirimā i te aukatinga iwi ā-roto o ngā kiritaki tokoiti. Tokowhā ngā kaiwhakaora hinengaro, whakatau “kirimā”, i uru mai ki ngā uiuinga kōkau, e tūhura ana i ō rātau whakaaro, mātauranga hoki he pēhea te putanga mai o te aukatinga iwi ā-roto i waenga i te nōhanga haumanu. I whāia te aromatawaihanga kaupapa hai aromatawai i te raraunga o ēnei uiuinga, ā, e whā ngā kaupapa i puta ake: ngā tohu o te aukatinga iwi ā-roto me te aukati iwi i roto i te haumanu, te tuakiri-ui, te mārama o te kaihaumanu me te here ki te ahurea. E whā ngā kaupapa huiroto tuatoko, taunaki hoki i ēnei kaupapa. He kanohitanga ēnei kaupapa i te tukanga haumanu o te: pueatanga, te māramatanga, te whakaurutanga me te whāinga. Te pueatanga ake o te aukatinga iwi me te aukatinga iwi ā-roto i rō haumanutanga e whakaāhua ana i te whaiaro aukatinga iwi ā-roto me te aukatinga iwi hoki o te kiritaki rāuatahi ko te kaiwhakaora hinengaro i te wā haumanutanga. E mau ana i te tuakiri-ui te tirohanga a ngā kaiwhakaora hinengaro o te aukatinga iwi ā-roto whakamahia ai hai tuakiri-whakaui pānga iwi, tuakiri-whakaui ahurea o ō rātau kiritaki tokoiti. He whakaaturanga haumanu aukati te whakamārama koi ā ngā kaihaumanu, ko te whakatau a te kaiwhakaora hinengaro ki ā rātau kiritaki tokoiti mō te rerekētanga iwi i waenga i a rātau. I te mutunga, ko te here ki te ahurea e hopu ana i te whāinga haumanu ā te kaiwhakaora hinengaro, arā ki te whakatenatena herenga tuku iho ā-iwi, ā-ahurea hai mea haumarutanga atu i te aukatinga iwi, whakararutanga kare ā-roto, hinengaro.

In 2016, the Older People’s Mental Health Service (OPMHS) within Bedfordshire and Luton (provided by East London Foundation National Health Service Trust) faced considerable challenges in providing an accessible service for assessment of suspected dementia. Those referred to the Memory Assessment Service (MAS) encountered waiting times exceeding national recommendations. A quality improvement (QI) project was initiated by OPMHS Psychologists within all four multidisciplinary MAS clinics in Bedfordshire and Luton. The project aimed to reduce the time from the date of referral for within-team neuropsychological assessment to finalisation of the report to 6 weeks (42 days) by April 2017. In parallel to the initiative, the wider impact of the QI project was investigated. Through the combination of change ideas tested and implemented, all four MAS clinics were successful in meeting the primary project aim. The combined mean time between referral received by psychology and report finalised reduced by 28.76 days from 65.1 to 36.34 days, and with reduced variation across the clinics. These changes were sustained throughout the duration of the project and beyond, and successful change ideas were incorporated into routine practice with control methods developed. Exploring the wider impact, a focus group with six psychology staff members involved in the project was also completed. Thematic analysis identified three themes from the focus group: staff impact, service impact and service user impact. Further subthemes were identified regarding both desirable and undesirable impact across the system. The approaches used may be useful for other services embarking on reduced wait time initiatives for access to care. Additionally, understanding ongoing areas of impact on staff, the wider service and service users can help reduce or mitigate undesirable or unintended consequences and work towards sustainability of such changes.

Objective Little has been published about maternity outcomes from New Zealand’s unique handling of the COVID-19 pandemic. Objectives were to determine obstetric outcomes between the variants, identify risk factors, and whether the changes to healthcare delivery affected pregnancy outcomes. Design This was a case control study comparing singleton pregnancies affected by the Delta and Omicron strains of COVID-19. The COVID 19-free controls were from 2019. Setting & Population The largest tertiary maternity unit in New Zealand providing taxpayer funded healthcare to a multi-ethnic, high deprivation index population with complex health needs. Methods Data were extracted from electronic record systems and further verified by reviewing patient’s notes. The risk of an event was modelled with logistic regression. The multivariate analyses adjusted for known clinical risk factors and other significant differences between the groups. Main Outcome Measures Outcomes of interest included admission for COVID-19, adverse pregnancy outcomes, including placentally-mediated ones. Results In the study population of > 8,000 pregnancies, Delta variant was associated with significantly worse maternal and obstetric outcomes. Fetal anomalies and most placentally-mediated adverse outcomes of pregnancy in the COVID-19 affected cohort did not persist once adjusted for underlying maternal risk factors, except for a 4-fold increased risk of stillbirth. Vaccination was protective against admissions and severe disease (OR 0.19;95%CI 0.11-0.32). Conclusions While the Delta variant has been associated with poorer outcomes, modifications to the delivery of maternity care during the pandemic could have unintended consequences on how patients utilised healthcare; this may have contributed to poorer outcomes.